Expanding the Scope of APRN's Does Not Endanger Patients

nomadcrna, DNP, CRNA, NP · Jan 17, 2014

That is not evidence. The actual evidence shows that our outcomes are equal or better than physicians. The studies have been posted numerous times. Look them up.

BTW, we are not comparing apples to oranges as in Family practice NPs to general surgeons. So there is no fellowship involved.

Length of school is not an indicator of quality care or outcomes.

This is a very simple view and shows that you do not understand evidenced based medicine or scientific studies. No offense intended.

By your reasoning, since I went to 13 years of school I give better medical care and have better outcomes.

I found out long ago that the initials don't mean much, it is the person. I've seen good and bad physicians, NPs and Pas. We all have our strong points and areas of interest/expertise.

I will say that comparing NPs to physicians right of school is different. I would give physicians the win in this case only because their clinical residency is longer.

PwettyPrincess · Jan 17, 2014

^You didn't read my original post. I said that physicians, "know more than NPs." I never said anything about patient care; you are assuming too much. You asked me to give you evidence on how they know more, and I did since they do more school and see more cases during their residencies. In addition, their boards are much more difficult than the boards NPs must take.

nomadcrna, DNP, CRNA, NP · Jan 17, 2014

Sorry, evidence does not support your premise. That does not prove that physicians "know" more. LOL

How do you know their boards are more difficult? Have you taken either one? Doubtful.

You are NOT a NP. Of this I am totally sure.

So you really do not have even the most basic knowledge to have an educated opinion. So again, no offense intended. Your opinion actually means very little. :)

In any case, your premise does not hold water.

PwettyPrincess · Jan 17, 2014

^Of course my argument holds water! Medical students have a marathon of exams (STEP 1, 2, 3) they must pass in order to get into a residency and then pass boards to practice on their own. NPs do not have the "knowledge" to pass these exams because they never took the upper level classes that covers the material on the STEP tests. Getting a good score on the STEP tests means you studied your ass off and are "knowledgeable" on the subjects.

nomadcrna, DNP, CRNA, NP · Jan 17, 2014

Actually many of us did take the same science education as med. students. But that still means very little in your argument.

Again, if we take that premise. I would be more knowledgeable than the average physician since I went to more years of medical education.

If your premise was true, why do I get consults for central lines, airway management, trauma resuscitation because the FP physician on ER call can't place a chest tube or handle anything more than bumps and bruises? On the other hand, I may call on them for women's health issues (one of my weak areas) or other areas that they are strong in. Does this make either of us "bad" or less knowledgeable? No, anyone with half a brain and not egotistical would see this.

Have you forgotten about the many NPs who are voluntarily taking the USMLE step 3 equivalency exam? And passing I might add.

It is pretty obvious that you are a med. student or physician troll. I'd be embarrassed if I were so insecure to come here and pontificate.

So don't be so insecure. There is room for you at the table. Be intellectually honest and admit that NPs outcomes are as good. Understand collaboration is the future and that it works BOTH ways.

Now my discussion with you is over. I make it a policy to not feed the trolls.

futureeastcoastNP · Jan 17, 2014

PwettyPrincess is probably right - I'm sure, on average, MDs know more than NPs. They do take a number of courses than NPs never even touch in their entire careers, such as biochemistry, histology, etc. In addition, their schooling goes down to a cellular and chemical level beyond the vast majority of NP programs. Despite this, there are three caveats:

1. Just because the average is likely higher for MDs doesn't mean it's always true - there is no absolute here. There are many NPs who work in research, have other degrees in pharmacology or biomedical science, have multiple publications, or just read a lot of journals. There are large number of NPs who "know more" than physicians because of that. Ones choice of career path doesn't automatically change their intelligence level.

2. Knowing more doesn't translate into better clinical care or outcomes. Much of the information physicians learn in school is extraneous and useless once in practice.

3. APRNs in a given specialty certaintly know more than MDs of another specialty. I'd rather have an EM NP deal with me in the ED than a gastroenterologist, no matter how much school he's had. I'd rather have anesthesia from a CRNA than a neurosurgeon, etc, etc.

In other words, the statement PwettyPrincess made is like saying that "Pears are better than Apples because they take longer to grow." Sometimes it's true, sometimes it's not, and it depends on what you're looking for at the moment.

PwettyPrincess · Jan 17, 2014

Nomad

^Funny you should mention NPs voluntarily take Step 3! Did you know that a majority of them fail!?!?

nomadcrna, DNP, CRNA, NP · Jan 17, 2014

FutureNP,

Great post. Very articulate. :)

Just as an aside. Many NP programs and all CRNA programs require many of the same sciences such as biochem and genetics. Many BSN programs are requiring organic and biochem.

Certified Registered Nurse Anesthetist Admission Requirements | Samuel Merritt University

Prerequisite Courses

[TABLE=width: 693]

[TR]

[TD]Chemistry: content should include organic, inorganic, and biochemistry content (required)[/TD]

[TD]6-8 sesmter units; 8-12 quarter units[/TD]

[/TR]

[TR]

[TD]Statistics (required)[/TD]

[TD]3 semester units; 4 quarter units[/TD]

[/TR]

[TR]

[TD]Physics: basic/introductory or general (highly recommended)[/TD]

[TD]3 semester units; 4 quarter units[/TD]

[/TR]

[/TABLE]

https://learn.uvm.edu/health-3/post-baccalaureate-premedical-program/professional-tracks/become-a-nurse-practitioner/

SAMPLE CURRICULUM:

In order to be admitted to a NP program, prospective students with a bachelor’s degree but without required undergraduate sciences can take advantage of the Pre-Nurse Practitioner track in UVM’s Post Baccalaureate Premedical Program.

2 semesters Human Anatomy & Physiology 8 credits

2 semesters Chemistry with lab 8 credits

1 semester Microbiology with lab 4 credits

1 semester Human Nutrition 3 credits

1 semester Statistics 3 credits

1 semester Human Development (across the lifespan) 3 credits

Recommended:

Courses in Biology, Psychology, Sociology, and English

Curriculum Tracks for Physician Assistant and Nurse Practitioner Programs

NOTE: These programs vary widely regarding course requirements. Researching programs of interest and summarizing the courses required will be necessary before you can determine your specific needs. Our Advisor is available to assist you regarding your plan. These plans include more courses than some programs require. Also, you may have recently completed some of the required courses as part of your undergraduate degree, thereby reducing the number of courses needed.

Option A: Summer Term Start

Summer Term

2 Anatomy and Physiology with labs: ANPS 19 & ANPS 20, 4 credits each (also available during the academic year.)

Fall Term

1 Principles of Biology, BIOL 001, 4 credits

1 General Chemistry: Either Outline of General Chemistry, CHEM 23 or General Chemistry, CHEM 31, 4 credits

1 English, 3 credits

1 Abnormal Psychology, PSYC 152, 3 credits

Prep for and/or take GRE

Spring Term

1 Principles of Biology, BIOL 002, 4 credits

1 Outline of Organic & Biochemistry, CHEM 26, 4 credits, or Outline of Organic Chemistry, CHEM 42, 4 credits, or General Chemistry 2, CHEM 32, 4 credits NOTE: Some more selective programs require two General Chemistry courses (CHEM 31 & 32) plus a biochemistry.

1 Statistics, STAT 111, 3 credits

1 Nutrition, NFS 43, 3 credits

Summer Term

1 Genetics, BCOR 101, 3 credits

1 Sociology, Social Organization of Death & Dying, SOC 154, 3 credits

Option B: Fall Term Start

Fall Term

1 Human Anatomy & Physiology, ANPS 19, 4 credits

1 General Chemistry: Either Outline of General Chemistry, CHEM 23 or General Chemistry, CHEM 31, 4 credits

1 English, 3 credits

Spring Term

1 Human Anatomy & Physiology, ANPS 20, 4 credits

1 Outline of Organic & Biochemistry, CHEM 26, 4 credits, or Outline of Organic Chemistry, CHEM 42, 4 credits, or General Chemistry 2, CHEM 32, 4 credits NOTE: Some more selective programs require two General Chemistry courses (CHEM 31 & 32) plus a biochemistry.

1 Statistics, STAT 111, 3 credits

1 Psychology, Abnormal Psychology, PSYC 152, 3 credits

Summer Term

2 Principles of Biology courses with labs, BIOL 001 & 002, 4 credits each

Fall Term

1 Biochemistry, Agricultural Biochemistry PBIO 185, 3 credits

1 Microbiology, Microbiology & Infectious Disease, MMG 101, 4 credits

1 Nutrition, NFS 43, 3 credits

Between terms prepare and/or take GRE

Spring Term

1 Genetics, BCOR 101, 4 credits

1 Psychology, 3 credits

1 English, 3 credits

JeanettePNP, MSN, RN, NP · Jan 17, 2014

The issue at hand is not "knowledge," it's the ability to give good patient care. That is the only relevant metric for the purposes of this thread, and the evidence amply demonstrates that NP's do have this ability, regardless of their perceived knowledge base or intelligence level.

Having a strong knowledge base is useless if you don't know how to apply it in clinical practice. It's useless if you don't know how to listen to patients, take a history effectively, or communicate your plan of care. It's useless if you lack insight into your own deficiencies and are not ready to ask for help when you need it. It's useless if you cannot work collaboratively with ALL members of the healthcare team (from fellow physicians, to NP's, RN's, and down to CNA's, secretaries and housekeepers).

With medical knowledge expanding exponentially, nobody, even the biggest expert, knows it all. They know who to consult and they know which questions to ask. NP scope is more limited than an MD. But as long as we stick to our scope of practice and training, we CAN perform the same job as MD's and deliver high quality care -- in some cases even better, in those "routine," boring cases that only require a listening ear and patience to explain to the patient (for the 20th time) WHY and HOW to use their medication.

PwettyPrincess · Jan 17, 2014

FutureNP,
Great post. Very articulate. :)
Just as an aside. Many NP programs and all CRNA programs require many of the same sciences such as biochem and genetics. Many BSN programs are requiring organic and biochem.
Certified Registered Nurse Anesthetist Admission Requirements | Samuel Merritt University
Prerequisite Courses
[TABLE=width: 693]
[TR]
[TD]Chemistry: content should include organic, inorganic, and biochemistry content (required)[/TD]
[TD]6-8 sesmter units; 8-12 quarter units[/TD]
[/TR]
[TR]
[TD]Statistics (required)[/TD]
[TD]3 semester units; 4 quarter units[/TD]
[/TR]
[TR]
[TD]Physics: basic/introductory or general (highly recommended)[/TD]
[TD]3 semester units; 4 quarter units[/TD]
[/TR]
[/TABLE]
https://learn.uvm.edu/health-3/post-baccalaureate-premedical-program/professional-tracks/become-a-nurse-practitioner/
SAMPLE CURRICULUM:
In order to be admitted to a NP program, prospective students with a bachelor's degree but without required undergraduate sciences can take advantage of the Pre-Nurse Practitioner track in UVM's Post Baccalaureate Premedical Program.
2 semesters Human Anatomy & Physiology 8 credits
2 semesters Chemistry with lab 8 credits
1 semester Microbiology with lab 4 credits
1 semester Human Nutrition 3 credits
1 semester Statistics 3 credits
1 semester Human Development (across the lifespan) 3 credits
Recommended:
Courses in Biology, Psychology, Sociology, and English
Curriculum Tracks for Physician Assistant and Nurse Practitioner Programs
NOTE: These programs vary widely regarding course requirements. Researching programs of interest and summarizing the courses required will be necessary before you can determine your specific needs. Our Advisor is available to assist you regarding your plan. These plans include more courses than some programs require. Also, you may have recently completed some of the required courses as part of your undergraduate degree, thereby reducing the number of courses needed.
Option A: Summer Term Start
Summer Term
2 Anatomy and Physiology with labs: ANPS 19 & ANPS 20, 4 credits each (also available during the academic year.)
Fall Term
1 Principles of Biology, BIOL 001, 4 credits
1 General Chemistry: Either Outline of General Chemistry, CHEM 23 or General Chemistry, CHEM 31, 4 credits
1 English, 3 credits
1 Abnormal Psychology, PSYC 152, 3 credits
Prep for and/or take GRE
Spring Term
1 Principles of Biology, BIOL 002, 4 credits
1 Outline of Organic & Biochemistry, CHEM 26, 4 credits, or Outline of Organic Chemistry, CHEM 42, 4 credits, or General Chemistry 2, CHEM 32, 4 credits NOTE: Some more selective programs require two General Chemistry courses (CHEM 31 & 32) plus a biochemistry.
1 Statistics, STAT 111, 3 credits
1 Nutrition, NFS 43, 3 credits
Summer Term
1 Genetics, BCOR 101, 3 credits
1 Sociology, Social Organization of Death & Dying, SOC 154, 3 credits
Option B: Fall Term Start
Fall Term
1 Human Anatomy & Physiology, ANPS 19, 4 credits
1 General Chemistry: Either Outline of General Chemistry, CHEM 23 or General Chemistry, CHEM 31, 4 credits
1 English, 3 credits
Spring Term
1 Human Anatomy & Physiology, ANPS 20, 4 credits
1 Outline of Organic & Biochemistry, CHEM 26, 4 credits, or Outline of Organic Chemistry, CHEM 42, 4 credits, or General Chemistry 2, CHEM 32, 4 credits NOTE: Some more selective programs require two General Chemistry courses (CHEM 31 & 32) plus a biochemistry.
1 Statistics, STAT 111, 3 credits
1 Psychology, Abnormal Psychology, PSYC 152, 3 credits
Summer Term
2 Principles of Biology courses with labs, BIOL 001 & 002, 4 credits each
Fall Term
1 Biochemistry, Agricultural Biochemistry PBIO 185, 3 credits
1 Microbiology, Microbiology & Infectious Disease, MMG 101, 4 credits
1 Nutrition, NFS 43, 3 credits
Between terms prepare and/or take GRE
Spring Term
1 Genetics, BCOR 101, 4 credits
1 Psychology, 3 credits
1 English, 3 credits

Nomad, you're confused. We aren't talking about undergrad courses.

JeanettePNP, MSN, RN, NP · Jan 17, 2014

Nomad, I wouldn't go that route. I have no problem acknowledging that med school curriculum is more rigorous than the typical NP program. As an NP the important thing is to recognize what you know and what you need to know to provide good patient care. I try to expand my knowledge all the time through reading textbooks, medical journals, etc. But I wouldn't get into a spitting contest with any MD with a fragile ego. My time is too valuable to waste on such juvenility.

PwettyPrincess · Jan 17, 2014

^Sounds like you are very sensitive about this topic!! Clearly you have been put into situations where MDs questioned your education and knowledge on certain matters. Your passive-aggressive posts show you have pent-up anger from your work environment and I think it's great that you're expressing it on this forum!!!!